J Bone Metab.  2019 May;26(2):89-95. 10.11005/jbm.2019.26.2.89.

Preventive Effects of Low Parathyroid Hormone Levels on Hip Fracture in Patients with Vitamin D Deficiency

• Byun SE
• Lee S
• Kim JW
• Ha YC
• Kim CH
• Ha C
• Ryu KJ
• Koh JM
• Kim HK
• Chang JS

• KMID: 2448956
• DOI: http://doi.org/10.11005/jbm.2019.26.2.89

Abstract

BACKGROUND
The objective of the current study is to determine the role of serum parathyroid hormone (PTH) on hip fracture development by retrospectively analyzing the relationship between vitamin D and PTH levels and hip fracture prevalence.
METHODS
Among 288 patients over 50 years of age, 113 patients with hip fracture and 111 controls without fracture were analyzed after excluding patients with conditions affecting bone metabolism. Bone mineral density and serum biochemical markers were measured, while demographic data were obtained. Patients were divided into 4 groups according to serum 25-hydroxy-vitamin D (25-[OH]D) and PTH levels: LowD+LowP (low 25[OH]D and PTH); LowD+HighP, (low 25[OH]D and high PTH); HighD+LowP (high 25[OH]D and low PTH); and HighD+HighP, patients with (high 25[OH]D and PTH). Measured values and percentages of patients with hip fracture in each group were then determined and compared.
RESULTS
The number of patients included in the LowD+LowP, LowD+HighP, HighD+LowP, and HighD+HighP groups was 116, 17, 87, and 4, while the percentages of patients with hip fracture in the same groups were 60.3%, 88.2%, 27.6%, and 100%, respectively. The percentage of hip fracture was significantly lower in the LowD+LowP than the LowD+HighP group (P=0.049).
CONCLUSIONS
Patients with low serum 25(OH)D and PTH levels showed lower hip fracture prevalence, indicating the potential protective role of low PTH levels on bone health in patients with vitamin D deficiency. Therefore, clinicians should pay more attention to the possibility of fractures in patients with vitamin D deficiency who present with high PTH levels.

Keyword

Hip fractures; Hypoparathyroidism; Parathyroid hormone; Vitamin D deficiency

MeSH Terms

Biomarkers
Bone Density
Hip Fractures
Hip*
Humans
Hypoparathyroidism
Metabolism
Parathyroid Hormone*
Prevalence
Retrospective Studies
Vitamin D Deficiency*
Vitamin D*
Vitamins*
Biomarkers
Parathyroid Hormone
Vitamin D
Vitamins

Figure

• 

  Fig. 1 A flow chart of the retrospective analysis. This retrospective study was conducted by enrolling 288 patients who underwent hip surgery between 2011 and 2013. After excluding those unsuitable for analysis, 224 patients were ultimately included in this study. Patients were divided into 4 subgroups according to serum 25-hydroxy-vitamin D (25[OH]D) 3 and parathyroid hormone (PTH) levels.

• 

  Fig. 2 Scatter diagram showing the proportion of hip fractures. The circle indicates the control group, while the orange square indicates patients with hip fracture. The low 25-hydroxy-vitamin D (25[OH]D) and high parathyroid hormone (PTH) group showed a higher percentage of fracture patients than the low 25(OH)D and low PTH group.

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